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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminisfrafor -0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> rn O <br /> y <br /> all <br /> OWNER�uolJ1 TELEPHONE �t 5 - 36 lD <br /> t �1 7T� m p- O <br /> MAILING ADDRESS �p�y-lC / 0.nb� r W� S 8 3 y v 1 0 <br /> Vl\ �r� l_ 4— o <br /> PROPERTY ADDRESS A-6 <br /> LEGAL DESCRIPTION(see tax receipt) vCj <br /> n <br /> DWELLING/BUILDING ❑RAGE/ACCESSORY STRUCTUREX ADDITION ❑ (n 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: ft rAe <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m Q) <br /> 11 E <br /> BUILDING CONTRACTOR: Moe ^ c ttdgnS Al A � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 [� <br /> �t <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T �- vl� <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF J Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. a <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 t <br /> O � r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z R 1410 <br /> CONDITIONS OF PERMIT: � 1, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Qr� tt <br /> ISSUANCE. .� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. eD <br /> 4. NO STRUCTURES, INCLUDING RFTAININr;WAI I S FTC At I OWFD WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> c <br /> pmm0Da : m <br /> 6 habitation. 0 D 3 a FR <br /> omC: o 3 <br /> 7. 0Z N (A `�0 <br /> �, <br /> = rnm: u <br /> I declare that this application (including any accompanying scneoule) has peen exammea oy me ana to the best of my A <br /> j a <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m' 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am v o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized persgjlto have access to the above described premises at any reasonable time for the quirpose of inspection. CD <br /> CD m o <br /> m D <br /> SIGN HERE in L111bS <br /> (s' not a of ow building contractor) (date) (N o <br /> ZONING ADMINISTRATOR ! <br /> ouNioc�"'i� cWn cNi, o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />